The Lessons From 'The Biggest Loser' in the Age of Ozempic

New Netflix docuseries 'Fit for TV: The Reality of the Biggest Loser' sheds light on the highly controversial reality TV show and participants' lives years later. Some are left with deep emotional scars and broken metabolism, sending a dire warning about extreme weight loss.

Publicly weighing people with obesity, forcing them to exercise until they vomit, and testing their temptation with pizzas and cakes is unthinkable on national TV these days.

However, this was the reality of 'The Biggest Loser,' which first aired on NBC in 2004 and ran for 17 seasons.

Watched by millions of people in the United States and worldwide, the participants experienced rapid and dramatic body transformations through aggressive methods.

In the age of Ozempic and other GLP-1 medications, the lessons from 'The Biggest Loser' about sustainable weight loss and metabolism are more relevant than ever.

Long-lasting effects of toxic messages

'The Biggest Loser' symbolizes everything that is wrong with how we think about body image and how much people should or shouldn't weigh, according to Melissa Gallagher, LCADC, LCSW, CCS, and executive director at Victory Bay.

As a therapist working with people with eating disorders, Gallagher has seen the long-lasting effects of toxic messages spread on the show years after it was taken off the air. She says such shows exacerbate the mental health problems that lead to such an unhealthy relationship with food and exercise.

However, the most insidious lesson from 'The Biggest Loser' is that extreme deprivation, punishment-based exercise, and public shaming are perfectly legitimate ways to lose weight.

I work with clients who sputter words they heard from the coaches on the show still, to pump themselves up, and when they can't meet an unsustainable pace, they call themselves 'lazy' and say they are 'tired of making excuses.' This internalized weight stigma leads to shame and self-hatred, which drives behavior such as binge-eating, over-exercise, and yo-yo dieting.

Melissa Gallagher, LCADC, LCSW, CCS

Ashley Koff, RD, the founder of the Better Nutrition Program (BNP), who was a dietitian for the TV reality show 'Shedding for the Wedding,' says that there is almost nothing to gain from such shows about sustainable weight loss.

Due to chasing ratings and production costs, these shows encourage weight loss in a short period of time.

Another drawback is that weight loss in these shows is measured as a total number and takes no credit for gaining muscle and losing fat, she says. Moreover, they don't provide personalized plans, and what works for the TV may not work for the viewers.

Is metabolic adaptation to blame?

In the Netflix documentary, some participants reported experiencing what is called 'metabolic adaptation.'

We burn about 60-70% to maintain basic life functions like sleep and breathing, and this number is called resting metabolic rate (RMR). This means individuals who are overweight or have obesity burn more calories at rest than thinner people.

When we lose weight, our RMR slows down. Metabolic adaptation occurs when RMR doesn't increase despite regaining lost weight.

According to a 2016 study that followed 14 participants of 'The Biggest Loser,' most regained a significant amount of the weight lost during the competition. Despite that, RMR remained suppressed at the same average level as at the end of the weight loss competition. It was about 500 kcal per day lower than expected based on the body composition.

Experiencing extreme exercise and calorie restriction, people's bodies adapt by slowing metabolism dramatically and increasing hunger hormones as a way to survive, says Katherine Metzelaar, a registered dietitian and owner at Bravespace Nutrition. This happens regardless of body size.

However, the same study also found that some participants who were most successful at maintaining lost weight after six years also experienced greater metabolic slowing.

Such findings illustrate the ongoing debate about the relationship between metabolic adaptation and weight regain. For example, a 2020 study suggested that metabolic adaptation didn't correlate with regaining weight, with authors calling the phenomenon 'an illusion.'

Another study associated metabolic adaptation with a greater increase in appetite following weight loss, but not regaining weight. The authors said this could explain why individuals experience different outcomes to dietary interventions.

Healthy metabolism on Ozempic

Nearly a decade since the show ended, the number of American adults who are overweight or have obesity has increased to about 70%.

While the non-medical weight loss market was worth $38.4 billion in 2024, there is an increasing use of pharmacological means, particularly GLP-1 medications, short for glucagon-like peptide-1 agonists.

The most effective GLP-1s may help to lose over 20% of body weight in 72 weeks when combined with exercise and a balanced diet. Gastrointestinal side effects like nausea and vomiting with them are common, and evidence suggests that they may lead to adverse events such as pancreatitis and stomach paralysis.

Metzelaar says adequate protein intake may help to decrease some of the long-term slowing of metabolism after weight loss. However, our human bodies resist weight loss and will adapt to protect the body's well-being and survival.

The use of GLP-1s doesn't always guarantee sustained weight loss either. A 2025 systematic review suggests that most weight lost on these drugs returns within a year after discontinuation.

This is how bodies are wired despite the cultural narratives that weight loss is 'sustainable' and blames individuals for not being able to maintain it, which leads to lots of shame and weight cycling, both of which the research shows is not health supportive.

Katherine Metzelaar, RD

Weight cycling – the repeated loss and gain of weight – has been associated with increased cardiovascular risk factors, such as high blood pressure and heart rate, among others.

Suzanne Mendonca, a former contestant of 'The Biggest Loser,' who regained most of the weight after the show, admitted turning to a GLP-1 medication to address health issues like hypertension, asthma, and diabetes.

GLP-1s have been shown to not only significantly improve blood glucose regulation and reduce weight, but also benefit heart health. Wegovy, one of the drugs in the class, has been FDA-approved for reducing the risk of cardiovascular death, heart attack and stroke.

Despite the risk of serious side effects, GLP-1s are normally taken under the supervision of a healthcare provider and in combination with healthy lifestyle changes. This comes as a stark contrast to aggressive and potentially dangerous weight loss methods used on 'The Biggest Loser.'

Still, what can one do to protect their metabolism while losing weight on GLP-1s? Koff says the first thing to do is to stop going for rapid weight loss.

"Focus on fat loss at a better pace while gaining or protecting bone and muscle," she tells WellnessPulse.

Staci Gulbin, MS, MEd, RDN, says individuals experiencing rapid weight loss, including on Ozempic and similar drugs, may try to prevent or alleviate metabolic adaptation by developing healthy habits that will support gut health. In turn, it may help reduce the risk of inflammation-related conditions like type 2 diabetes.

The ways to do it include taking probiotics daily and consuming plenty of antioxidant-rich foods like fruits, vegetables, nuts, and seeds daily. Consuming omega-3 fatty acid rich olive oil and fatty fish several times a week is also advised.

Dr. Wiljon Beltre, a bariatric surgeon at Beltre Bariatrics, recommends adding more protein and pairing it with resistance or strength training, even light weights or bodyweight exercises, to protect lean body mass.

Getting enough sleep, staying hydrated and checking in regularly with a healthcare provider can also help keep your metabolism healthier during a period of rapid weight loss.

I lost weight. What's next?

Gallagher says maintaining a healthy weight is all about healing your relationship with food and your body, and not about fighting against it. She points out that 'The Biggest Loser' winners who maintained significant weight loss did not keep up with the extreme methods of the show. Instead, they found gentler, more sustainable methods to heal their emotional eating habits.

"The real lesson of 'The Biggest Loser' is that transformation happens through self-compassion, consistent small changes, and getting to the bottom of what is driving the traumatized and overwhelmed people who eat and live unhealthily," Gallagher tells WellnessPulse.

Beltre recommends building a lifestyle of healthy habits. This includes focusing on balanced meals, including lean proteins, fiber-rich vegetables, healthy fats, and whole grains. Keeping portion sizes reasonable is also important.

Strength training can help preserve muscle, but what also matters is finding a physical activity that you'll actually stick with long-term.

What's just as important is your mindset; don't look at weight loss as an endpoint, but as the start of your new normal. Small, consistent habits, not extreme measures, are what keep the weight off for good.

Dr. Wiljon Beltre

The verdict

'The Biggest Loser' reality TV show teaches us that rapid weight loss using aggressive methods isn't sustainable, and may have long-lasting consequences on mental and physical health.

Those who are on their weight loss journey with GLP-1 medications may want to do it at a slower pace, while following a diet rich in protein and antioxidant-rich foods, engaging in strength and resistance training, and getting adequate sleep.